Early Seizures after Surgery Predict More Seizures

Anne M. McIntosh, Ph.D., of the University of Melbourne in Australia and colleagues found that patients who experienced a seizure in the four weeks following surgery - in the absence of surgery-related triggers such as trauma or swelling - were eight times more likely to have persistent epilepsy several months later. Even among the patients with evidence of these seizure triggers there was a three-fold increase in the likelihood of continuing epilepsy.

The prevailing medical understanding of seizures in the weeks just after epilepsy surgery is that they are likely to be temporary, probably due to swelling or minor trauma suffered by the brain during the operation.

"These findings have implications for patient counselling, but they are also interesting in terms of understanding epilepsy," said lead author Anne M. McIntosh. "We can speculate that some individuals who undergo this procedure have epilepsy that for some reason is more persistent."

Given that surgery is only performed in cases where the disease is debilitating, these results do not cast doubt on the procedure itself. "Many subjects who have a return of epilepsy still have ongoing benefit from the procedure in terms of reduced seizure frequency," said McIntosh.

"About 20 percent of patients have epilepsy that does not respond to medication, and perhaps a third of these may be suitable for surgery," said McIntosh.

This is particularly true of temporal lobe epilepsy, where seizures begin in the temporal lobe of the brain and spread to other regions.